Provider Demographics
NPI:1619114758
Name:AMAZING COMMUNITY SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:AMAZING COMMUNITY SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-630-2025
Mailing Address - Street 1:111 LAMON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4901
Mailing Address - Country:US
Mailing Address - Phone:910-630-2025
Mailing Address - Fax:910-630-2057
Practice Address - Street 1:111 LAMON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4901
Practice Address - Country:US
Practice Address - Phone:910-630-2025
Practice Address - Fax:910-630-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC111111Medicaid